No Neurology Consult: MICU Intern Startles All

PHILADELPHIA, PA – During their daily rounds on all the patients with altered mental status in the medical intensive care unit (MICU), the neurology consult team noticed that they were not consulted on a patient. When the team, which was still divided on whether they should be grateful or offended, opened the patient’s chart, they were horrified to know that the patient, a middle-aged male with sepsis, pneumonia, alcoholic liver failure, and renal failure getting dialysis has been in the ICU for more than 3 days already!

Altered mental status in a MICU patient with multi-organ system failure is one of the most frequent and cherished consults by neurology residents.

Bell Hammerman, a PGY-4 neurology resident, said, “I made a template one week into my neurology residency for this specific consult which already has an assessment and plan:

– Exam limited by sedatives. Recommend EEG and MRI brain. – This is most likely metabolic encephalopathy in the setting of multi-organ failure. Recommend correction of underlying metabolic abnormalities.

“After using this template for so long, I can’t believe that it may not be of use anymore. This is indeed a bittersweet end to my residency.”

As the neurology team begrudgingly left the MICU after trying take a peek into the patient’s room, a new MICU intern realized that he forgot to call a neurology consult even if his notes promptly state neurology on board!

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